Mechanical Ventilation in ARDS (+Protocol)

Mechanical Ventilation in ARDS - Goals and Limits

 

1. Initiate volume/pressure-limitied ventilation

 

Tidal volume ≤ 6ml/kg PBW

Plateau pressure ≤ 30 cmH20

RR ≤ 35bpm

 

2. Oxygenate 

 

Fio2 ≤ 0.6

PEEP ≤ 10cmH2O

SpO2 88 - 95%

 

3.  Minimize acidosis

 

pH ≥  7.30

RR ≤ 135 bpm

 

4. Diuresis 

 

MAP ≥ 65 mmHg

Avoid hypoperfusion

 

Ventilation protocol Used in the ARDS 

 

Mode of ventilation: Volume assist control

Tidal volume:  ≤ 6 mL/kg predicted body weight

Plateau pressure:  ≤ 30 cm H2O

Frequency: 6-35 breaths/min, titrated fo pH 7.3-7.45

I:E ratio: 1:1 to 1:3

Oxygenation goal: Arterial Po2 55-80 mm Hg, or SpO2 88%-95%

FiO2/PEEP(cm H2O) Combinations allowed :

0.3/5 0.4/5 0.4/8 0.5/8 0.5/10 0.6/10 0.7/10 0.7/12 0.7/14 0.8/14 0.9/14

0.9/16 0.9/18 1/18-24

Weaning

By pressure support, required when FiO2/PEEP ≤ 0.4/8